Severe Ischemia of the Hand Following Concomitant Catheterization of the Radial Artery and Systemic Administration of Dopamine

Abstract

Radial artery cannulation for monitoring of arterial pressure and blood gases has been employed as routine procedure in major cardiothoracic surgery. Complications such as gangrene of the hand are rare because there is extensive collateral arterial circulation to the hand. Dopamine, an inotropic agent often employed in the care of cardiothoracic patients, has been known to cause ischemia of the extremity in high doses. This is the first report of ischemia of the hand resulting from the combined use of radial artery catheter and dopamine. Two patients developed multiple extremity ischemia followed by loss of the catheterized extremity. One, a three-month-old boy, developed ischemia of the hand requiring eventual amputation. He had a radial artery catheter in situ for forty-eight hours and received thirty-six hours of standard dosage dopamine treatment. The other, a sixty-year-old woman, developed ischemia of thumb and index finger during eighteen hours of low-dose dopamine treatment and twenty-four hours of radial artery cannulation.